tbuckley/cabot-search huggingface dataset:
A randomized controlled experimental medicine study of ghrelin in value-based decision making
Authors: Michal Pietrzak, Adam Yngve, J. Paul Hamilton, Robin Kämpe, Rebecca Boehme, Anna Asratian, Emelie Gauffin, Andreas Löfberg, Sarah Gustavson, Emil Persson, Andrea J. Capusan, Lorenzo Leggio, Irene Perini, Gustav Tinghög, Markus Heilig
Journal: Journal of Clinical Investigation (2023)

BACKGROUND. The stomach-derived hormone ghrelin stimulates appetite, but the ghrelin receptor is also expressed in brain circuits involved in motivation and reward. We examined ghrelin effects on decision making beyond food or drug rewards, using monetary outcomes.
Percentage Error in Table
Authors: Debara Tucci, Robert Califf
Journal: JAMA (2023)

Donna Franklin, PhD, MBA, BN; Franz E. Babl, MD; Shane George, MBBS, MPH, BSc; Ed Oakley, MBBS; Meredith L. Borland, MBBS; Jocelyn Neutze, MBChB; Jason Acworth, MBBS; Simon Craig, MBBS, MHPE, MPH; Mark Jones, PhD; Brenda Gannon, PhD; Deborah Shellshear, MBBS; Hamish McCay, MBChB; Alexandra Wallace, PhD, DCH, MBChB, BHB; Tobias Hoeppner, MBBS; Mark Wildman, PhD, MBBS, BSc (Hons); Joerg Mattes, MD, PhD; Trang M. T. Pham, MEng, BEng; Letitia Miller, BN; Amanda Williams, BN; Sharon O’Brien, BN; Shirley Lawrence, BN; Megan Bonisch, BN; Kristen Gibbons, PhD; Susan Moloney, MBBS; John Waugh, MBBS; Sue Hobbins, MB, ChB, BSc (Med Sci); Simon Grew, MBBS; Rose Fahy, MBBS; Stuart R. Dalziel, PhD, MBChB; Andreas Schibler, MD
Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion
Authors: Cyrille Huchon, Hocine Drioueche, Martin Koskas, Aubert Agostini, Estelle Bauville, Nicolas Bourdel, Hervé Fernandez, Xavier Fritel, Olivier Graesslin, Guillaume Legendre, Jean-Philippe Lucot, Pierre Panel, Cyril Raiffort, Géraldine Giraudet, Laurence Bussières, Arnaud Fauconnier
Journal: JAMA (2023)

Importance Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility. Objective To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy. Design, Setting, and Participants The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio. Interventions Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286). Main Outcomes and Measures The primary outcome was a pregnancy of at least 22 weeks’ duration during 2-year follow-up. Results The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, −4.8% [95% CI, −13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups. Conclusions and Relevance Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases. Trial Registration ClinicalTrials.gov Identifier: NCT02201732
Nomograms for predicting the recurrence probability and recurrence-free survival in patients with hepatocellular carcinoma after conversion hepatectomy based on hepatic arterial infusion chemotherapy: a multicenter, retrospective study
Authors: Min Deng, Qiucheng Lei, Jiamin Wang, Carol Lee, Renguo Guan, Shaohua Li, Wei Wei, Huanwei Chen, Chong Zhong, Rongping Guo
Journal: International Journal of Surgery (2023)

This study aimed to establish and validate nomograms to predict the probability of recurrence and recurrence-free survival (RFS) in patients with hepatocellular carcinoma (HCC) after conversion hepatectomy based on hepatic arterial infusion chemotherapy (HAIC).Nomograms were constructed using data from a retrospective study of 214 consecutive patients treated with HAIC-based conversion liver resection between January 2016 and July 2020. Nomograms predicting the probability of tumor recurrence and RFS were established based on predictors selected by multivariate regression analysis. Predictive accuracy and discriminative ability of the nomogram were examined. Bootstrap method was used for internal validation. External validation was performed using cohorts ( n =128) from three other centers.Recurrence rates in the primary and external validation cohorts were 63.6 and 45.3%, respectively. Nomograms incorporating clinicopathological features of tumor recurrence and RFS were generated. Concordance index (C-index) scores of the nomograms for predicting recurrence probability and RFS were 0.822 (95% CI, 0.703-0.858) and 0.769 (95% CI, 0.731-0.814) in the primary cohort, and 0.802 (95% CI, 0.726-0.878) and 0.777 (95% CI, 0.719-0.835) in the external validation cohort, respectively. Calibration curves indicated good agreement between the nomograms and actual observations. Moreover, the nomograms outperformed the commonly used staging systems. Patients with low risk, stratified by the median nomogram scores had better RFS (low risk vs. high risk, 36.5 vs. 5.2 months, P <0.001). The external validation cohort supported these findings.The presented nomograms showed favorable accuracy for predicting recurrence probability and RFS in HCC patients treated with HAIC-based conversion hepatectomy. Identifying risk factors and estimating tumor recurrence may help clinicians in the decision-making process regarding adjuvant therapies for patients with HCC, which eventually achieves better oncological outcomes.
Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses
Authors: Andrew M. Ryan, Sukruth A. Shashikumar, Zoey Chopra, Karen E. Joynt Maddox, Jason D. Buxbaum
Journal: JAMA (2023)

This study examines the magnitude of reconciliation payments and clinical spending reductions necessary for the Centers for Medicare &amp;amp;amp; Medicaid Services to break even in the first 4 performance periods of the BPCI-A (Bundled Payments for Care Improvement Advanced) program.
SurgSmart: an artificial intelligent system for quality control in laparoscopic cholecystectomy: an observational study
Authors: Shangdi Wu, Zixin Chen, Runwen Liu, Ang Li, Yu Cao, Ailin Wei, Qingyu Liu, Jie Liu, Yuxian Wang, Jingwen Jiang, Zhiye Ying, Jingjing An, Bing Peng, Xin Wang
Journal: International Journal of Surgery (2023)

The rate of bile duct injury in laparoscopic cholecystectomy (LC) continues to be high due to low critical view of safety (CVS) achievement and the absence of an effective quality control system. The development of an intelligent system enables the automatic quality control of LC surgery and, eventually, the mitigation of bile duct injury. This study aims to develop an intelligent surgical quality control system for LC and using the system to evaluate LC videos and investigate factors associated with CVS achievement.SurgSmart, an intelligent system capable of recognizing surgical phases, disease severity, critical division action, and CVS automatically, was developed using training datasets. SurgSmart was also applied in another multicenter dataset to validate its application and investigate factors associated with CVS achievement.SurgSmart performed well in all models, with the critical division action model achieving the highest overall accuracy (98.49%), followed by the disease severity model (95.45%) and surgical phases model (88.61%). CVSI, CVSII, and CVSIII had an accuracy of 80.64, 97.62, and 78.87%, respectively. CVS was achieved in 4.33% in the system application dataset. In addition, the analysis indicated that surgeons at a higher hospital level had a higher CVS achievement rate. However, there was still considerable variation in CVS achievement among surgeons in the same hospital.SurgSmart, the surgical quality control system, performed admirably in our study. In addition, the system's initial application demonstrated its broad potential for use in surgical quality control.
In-hospital waiting time to surgery and functional outcomes in geriatric hip fractures: a directed acyclic graph-based preplanned analysis from a prospective multicenter cohort study
Authors: Qianying Cai, Kai Fu, Weitao Jia, Xiaolin Li, Haiyan He, Zhenjun Yao, Xiaodong Chen, Yuqi Dong, Qiugen Wang, Bin Kang, Biyun Qian, Shengbao Chen, Changqing Zhang
Journal: International Journal of Surgery (2023)

The early recovery of hip function after hip fracture surgery values more attention, especially for patients with delayed surgery of longer than 48 h. We aim to evaluate the associations of in-hospital surgical waiting time with the functional outcomes [Harris Hip Score (HHS), Parker Mobility Score (PMS), and EuroQol 5 dimensions VAS (visual analogue scale) score (EQ-5D VAS)] in elderly patients who sustained hip fractures.Data on sociodemographic and clinical factors were prospectively collected using a multicenter hip fracture registry system. Participants in the cohort underwent a 12-month follow-up investigation. After adjusting potential confounders identified by the directed acyclic graphs, the associations between surgical waiting time longer than 48 h and functional outcomes were estimated by log-binomial regression and multivariable linear regression models with generalized estimating equations.Of 863 survival participants with available functional data at 12 months after surgery, an increased risk was obtained from receiving surgery after 48 h and the poor functional outcomes (HHS<80: relative risk (RR)=1.56, 95% CI: 1.00-2.51; PMS<7: RR=1.49, 95% CI: 1.13-2.01; EQ-5D VAS<80: RR=1.97, 95% CI: 1.57-2.47). In-hospital waiting time greater than 48 h were time-invariantly associated with lower PMS during recovery (-0.44 units 95% CI: -0.70 to -0.18). In addition, delayed surgery was time-varying associated with HHS and EQ-5D VAS.The associations between in-hospital waiting time and postoperative functional score suggest that delayed surgery can lead to poor functional outcomes, especially in patients waiting longer than 72 h from injury. Delayed surgery mainly impacted hip function and mobility recovery with a slower speed in early recovery of the first 3 months. More attention should be paid to mechanisms behind the associations between delayed surgery on general healthy status.
Leveraging What Goes Right to Improve Perioperative Safety
Authors: Aussama K. Nassar, Sara Naomi Goldhaber-Fiebert
Journal: JAMA Network Open (2023)

Caoimhe Duffy, MD, MSc; Neil Menon, MD; David Horak, BS; Geoffrey D. Bass, MD, MBA; Ruchika Talwar, MD; Cara Lorenzi, BSN, RN, CCRN; Christina Taing Vo, MSN, CRNP; Chienhui Chiang, MSN, CRNP; Justin B. Ziemba, MD, MSEd
Microfluidic Spontaneous Emulsification for Generation of O/W Nanoemulsions—Opportunity for In‐Space Manufacturing
Authors: Svenja Schmidt, Anh The Nguyen, Huy Quang Vu, Nam Nghiep Tran, Maria Sareela, Ian Fisk, Volker Hessel
Journal: Advanced Healthcare Materials (2023)

The use of microfluidics for oil-in-water (O/W) nanoemulsification via spontaneous self-assembly is demonstrated. As this is known to be a longish process, both single- and multicontact microfluidic reactors are tested, the latter providing a longsome, constant microfluidic treatment to maintain advanced phase and interfacial mass transfer. Microfluidic devices provide strong advantages above conventional systems for spontaneous emulsification, with droplet sizes of 62 nm at desired surfactant-to-oil ratios (SOR) and a decrease of 90% in process time. Multicontact microfluidics have better performance than their single-contact counterparts, while critical aspects, e.g., process robustness, are also discussed. Ternary phase diagram analysis of the three components (oil, water, surfactant) allow to decide for the right mixing ratio and sequence of mixing steps for the nanoemulsions. Microfluidic spontaneous emulsification meets objective functions of the intended application to provide fortified beverages to astronauts in space exploration. In that viewpoint, an advantage is to achieve stable nanoemulsions at a level of concentrations much higher as compared to application (human intake), allowing a dilution factor to the final product of up to 100. This decreases notably the process time and allows for process flexibility, e.g., to dilute or tailor Earth-prepared nanoemulsion concentrate payloads in space.
Estimating human papillomavirus vaccine efficacy from a single-arm trial: Proof-of-principle in the Costa Rica Vaccine Trial
Authors: Brian Befano, Nicole G Campos, Didem Egemen, Rolando Herrero, Mark Schiffman, Carolina Porras, Douglas R Lowy, Ana Cecilia Rodriguez, John T Schiller, Rebecca Ocampo, Allan Hildesheim, Joshua N Sampson, Shrutikona Das, Aimée R Kreimer, Li C Cheung, Bernal Cortés, Paula González, Rolando Herrero, Silvia E Jiménez, Carolina Porras, Ana Cecilia Rodríguez, Allan Hildesheim, Aimée R Kreimer, Douglas R Lowy, Mark Schiffman, John T Schiller, Mark Sherman, Sholom Wacholder, Ligia A Pinto, Troy J Kemp, Mary K Sidawy, Wim Quint, Leen-Jan van Doorn, Linda Struijk, Joel M Palefsky, Teresa M Darragh, Mark H Stoler
Journal: JNCI Journal of the National Cancer Institute (2023)

Abstract Background The World Health Organization recommends a 1- or 2-dose human papillomavirus (HPV) vaccination schedule for females aged 9 to 20 years. Studies confirming the efficacy of a single dose and vaccine modifications are needed, but randomized controlled trials are costly and face logistical and ethical challenges. We propose a resource-efficient single-arm trial design that uses untargeted and unaffected HPV types as controls. Methods We estimated HPV vaccine efficacy (VE) from a single arm by comparing 2 ratios: the ratio of the rate of persistent incident infection with vaccine-targeted HPV 16 and 18 (HPV 16/18) and cross-protected types HPV 31, 33, and 45 (HPV 31/33/45) to vaccine-unaffected types HPV 35, 39, 51, 52, 56, 58, 59, and 66 (HPV 35/39/51/52/56/58/59/66) vs the ratio of prevalence of these types at the time of trial enrollment. We compare VE estimates using only data from the bivalent HPV 16/18 vaccine arm of the Costa Rica Vaccine Trial with published VE estimates that used both the vaccine and control arms. Results Our single-arm approach among 3727 women yielded VE estimates against persistent HPV 16/18 infections similar to published 2-arm estimates from the trial (according-to-protocol cohort: 91.0% , 95% CI = 82.9% to 95.3% [single-arm] vs 90.9% , 95% CI = 82.0% to 95.9% [2-arm]; intention-to-treat cohort: 41.7%, 95% CI = 32.4% to 49.8% [single-arm] vs 49.0% , 95% CI = 38.1% to 58.1% [2-arm]). VE estimates were also similar in analytic subgroups (number of doses received; baseline HPV serology status). Conclusions We demonstrate that a single-arm design yields valid VE estimates with similar precision to a randomized controlled trial. Single-arm studies can reduce the sample size and costs of future HPV vaccine trials while avoiding concerns related to unvaccinated control groups. Trial registration ClinicalTrials.gov Identifier: NCT00128661.
Artificial intelligence–derived dermatology case reports are indistinguishable from those written by humans: A single-blinded observer study
Authors: Charles Dunn, Jacob Hunter, William Steffes, Zackary Whitney, Michael Foss, Jere Mammino, Adam Leavitt, Spencer D. Hawkins, Alexander Dane, Martin Yungmann, Rajiv Nathoo
Journal: Journal of the American Academy of Dermatology (2023)
Pilot, open-label, single-arm clinical trial evaluating the efficacy of topical crisaborole for steroid refractory morphea
Authors: Amy J. Petty, Drew A. Emge, Sarah K. Blanchard, Maria Angelica Selim, Kim Scoggins, Beiyu Liu, Cynthia L. Green, Adela R. Cardones, Morgan E. Belina
Journal: Journal of the American Academy of Dermatology (2023)
Arterial cannulation during endoscopic retrograde cholangiopancreatography
Authors: Toji Murabayashi, Haruka Nakamura, Shinya Sugimoto, Jun Oyamada, Akira Kamei
Journal: Endoscopy (2023)

A 77-year-old woman was admitted to our hospital with jaundice. Contrast-enhanced computed tomography revealed a tumor in the pancreatic head with distal biliary obstruction ([Fig. 1]). The aorta and inferior mesenteric artery (IMA) were distorted to the right by severe scoliosis, which caused the IMA to run close to the tumor and the papilla of Vater ([Fig. 2]). Endoscopic retrograde cholangiopancreatography (ERCP) was performed for biliary drainage ([Video 1]). On ERCP, a guidewire was unintentionally inserted into the IMA and the aorta ([Fig. 3]). However, we were unable to recognize the insertion of the guidewire into the artery because of the similarity between the course of the aorta and the bile duct ([Fig. 2], [Fig. 3]). The passage of the catheter across the papilla along the guidewire was difficult because of the resisting force of the arterial wall, and was finally achieved by pushing the catheter repeatedly. Arterial blood, in which the partial pressure of oxygen was 151 mmHg, was collected using syringe suction via the catheter lumen. Pulsatile bleeding from the papilla was observed immediately after the catheter was removed ([Fig. 4]). Hemostasis was successfully achieved by compression for a few minutes using a balloon catheter. Seven days later, the patient underwent biliary drainage with endoscopic ultrasound-guided choledochoduodenostomy.
Novel therapeutic thin endoscope facilitates endoscopic submucosal dissection for cervical esophageal cancer involving the pharyngoesophageal junction
Authors: Teppei Masunaga, Motohiko Kato, Naohisa Yahagi
Journal: Endoscopy (2023)

The cervical esophagus, especially the pharyngoesophageal junction, is narrow; thus, the movement of the endoscope is severely limited [1] [2]. This region also has strong flexion to the posterior wall; thus, it is occasionally difficult to approach a lesion with a conventional endoscope with an insufficient downward angle. Recently, a novel therapeutic thin endoscope, EG-840TP (Fujifilm, Tokyo, Japan), has been developed. In this endoscope, despite an outer diameter of 7.9 mm, the working channel diameter is 3.2 mm with a downward angle of 160° ([Fig. 1], [Fig. 2]). Herein, we report a case in which this novel endoscope facilitates endoscopic submucosal dissection (ESD) for cervical esophageal cancer involving the pharyngoesophageal junction ([Video 1]).
A novel method of endoscopic submucosal dissection using a threaded clip for a lesion of the greater curvature of the gastric body
Authors: Keisaku Yamada, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Oonishi, Yasumasa Niwa
Journal: Endoscopy (2023)

Gastric endoscopic submucosal dissection (ESD) for lesions of the greater curvature of the gastric body is challenging owing to difficulty in approaching the lesion, submersion [1], and vertical confrontation with the lesion. Threaded-clip traction attached to the lesion is widely used in gastric ESD [2] [3]. We report a novel method of ESD using a threaded clip for a lesion of the greater curvature of the gastric body.
Closure of a giant gastroesophageal mucosal tear after peroral endoscopic myotomy with over-the-scope clip and cyanoacrylate
Authors: Oscar Víctor Hernández Mondragón, Luís Fernando García Contreras
Journal: Endoscopy (2023)

Insufflation-associated adverse events after peroral endoscopic myotomy (POEM) are frequent although innocuous in most of the patients [1] [2]. However, mucosal injuries could lead to perforation, mediastinitis, or bleeding that could be potentially fatal if not treated appropriately. Hemoclips, over-the-scope (OTS) clips [3], fully covered self-expandable metal stents (FCSEMSs) [4], and cyanoacrylate [5] have been used as alternative treatments for these cases.
Endoscopic ultrasound-guided antegrade dilation using a drill dilator for a pancreatojejunostomy anastomotic stricture, with pancreatoscopic findings
Authors: Takeshi Ogura, Junichi Nakamura, Jun Sakamoto, Yuki Uba, Hiroki Nishikawa
Journal: Endoscopy (2023)

Pancreaticojejunal anastomotic stricture (PJS) occurs as a complication after pancreaticoduodenostomy, with a reported incidence rate of 1.4 %–11.4 % [1]. Because abdominal pain or acute pancreatitis can occur in patients with a PJS, resolution of the PJS is desirable. The endoscopic approach is more often selected because, compared with surgical treatment, it is a noninvasive procedure. Although the enteroscopic approach is usually attempted [2] [3], it has disadvantages such as prolonged procedure time. Accordingly, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has been developed [4]. This alternative method is reported to have a high technical success rate and requires dilation of the PJS. The Tornus ES drill dilator (Asahi Intecc) ([Fig. 1]) has recently become available in Japan [5]. It enables the tract to be easily dilated using a clockwise rotation without any pushing force. We herein describe its successful use for dilation of a PJS, with the pancreatoscopic findings shown.
Successful direct clipping of the bleeding source of a colonic diverticular hemorrhage using the “long-hood gel-filling” method
Authors: Satoshi Abiko, Koji Hirata, Kazuharu Suzuki, Kenji Kinoshita, Kazuteru Hatanaka, Yoshiya Yamamoto, Hirohito Naruse
Journal: Endoscopy (2023)

Although various endoscopic hemostasis techniques for colonic diverticular bleeding have recently been reported [1], identifying the bleeding diverticulum among other diverticula is difficult [2], and identifying the bleeding vessels within the diverticulum is even more difficult. The usefulness of a long hood (MAJ663; Olympus) [3] and endoscopic-viewing gel (VISCOCLEAR) [4] [5] when identifying the bleeding diverticulum has recently been reported. Here, we report successful direct clipping of the bleeding source for a colonic diverticular hemorrhage using a long hood and gel (the "long-hood gel-filling method").
Specialized coaxial hepaticogastrostomy stent and lumen-apposing stent for salvage of dysfunctional EUS-guided cholecochoduodenostomy.
Authors: Albert Garcia-Sumalla, Sergi Quintana-Carbo, Joan B. Gornals
Journal: Endoscopy (2023)

Recurrent biliary obstruction after endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) performed using lumen-apposing metal stents (LAMSs) has become a major concern (reported in up to 26 %). Its management can be challenging and reported strategies include the insertion of a coaxial plastic double-pigtail stent (DPS) or tubular self-expandable metal stents [1] [2] [3]. Here we present a case in which a specialized hepaticogastrostomy biliary stent was used.